Non-communicable diseases (NCDs)
The cost-effectiveness of primary care services in developing countries: a review of the international literature
Literature review on primary health care
Authors:
J. Doherty; R. Govender
Publisher:
Disease Control Priorities Project, Maryland, 2004
Knowledge of the local or regional burden of disease is required for governments to understand what diseases are potential priorities requiring intervention within their own country’s borders. This Working Paper by The Disease Control Priorities Project shows how the burden of disease studies are extremely resource-intensive, particularly in low-income countries where data on cause of mortality is often of poor quality, and the assessment of morbidity is culturally complex and prohibitively expensive. The paper reviews literature which has emerged specifically on primary health care approaches that relate to individual- and family-based interventions.
The authors highlight that ideally conditions should be managed at the type of facility that is most cost-effective. As this review will show, this is often the primary level. They argue that, services should be moved upstream towards the primary level as much as possible. Many factors affect which package of interventions is both needed and cost-effective at a primary level. Other factors affect the ability of the health system to deliver the package at this level adequately. The paper discusses these factors and shows how the array of interventions that are appropriate to meet community needs vary from context to context, as does the ‘cut-off’ between various levels of care. In practice, limited resources and poor capacity at the primary level often mean that primary level services perform relatively limited functions.
